Pharmacy clinics draw skepticism even as customers flock in

May 28, 2013|By Sonja Isger

When Akim Reid needed a physical for his job, he couldn't turn to his regular doctor - he doesn't have one. The Loxahatchee, Fla., resident called around for someone to do the exam. Everyone he called could see him . next month.

So he went online for a clinic that could take him on short notice. He found one - his local pharmacy.

Wendy Sparapani has a pediatrician for her 16-year-old son Justin. But when Justin's persistent cough became overwhelming, she didn't even bother with the doctor's office. A pharmacy not far from her Jupiter, Fla., home could see him in minutes.

In the past decade, millions of Americans each year have skipped the doctor's office or emergency room and headed to a pharmacy for everything from a flu shot to treatment for strep throat.

The nation's largest drugstore chain, Walgreens, recently announced that staff at its 360 clinics can now assess, treat and manage more chronic illnesses such as asthma and diabetes.

Meanwhile CVS, where Reid and Sparapani sought help, boasts 640 Minute Clinics in the U.S. with plans to have 1,500 by 2017.

All these clinics are staffed by either nurse practitioners or physicians' assistants. Both can write prescriptions and have advanced degrees.

The clinics are clearly meeting a public demand - one that is forecast to grow as the population ages and the Affordable Care Act extends insurance to another 34 million people. A survey published in January indicates that more than one-quarter of Americans have been to one of these clinics in the past two years. They cite convenience - no appointments, short waits and extended hours - as reasons.

And three-quarters of them had health insurance.

Some physicians fear this expansion could poses a health threat to the people treated.

Instead of having a "medical home" where a physician knows the patient's history, more patients will be leaving pieces of their medical histories scattered about town in various pharmacies.

"What about your mammograms, what about your diet or mental health? They're going to take care of parts. They aren't going to provide comprehensive medical care," said Dr. Jeffrey Cain, president of the American Academy of Family Physicians, who practices in Denver.

Cain and the academy do not write off pharmacy clinics entirely.

"If they're doing it in collaboration with a primary care physician, sharing lab results and information . that could enhance their care. But how do you make sure that happens?" asked Cain.

It's often better for a patient to go to a pharmacy than clog the hospital emergency room, Fortier said.

"You need more ways to get care," Fortier said. "For the most part, I think it's going to increase that access to care."

That's important given that national health leaders forecast a shortage of 50,000 to 60,000 primary care physicians by 2025.

But when pharmacy clinics take on the treatment of more chronic conditions such as hypertension or diabetes, Fortier worries that they are taking on too much.

"The goal of the clinics from the very beginning was to work in collaboration with the medical community," said Sandra Ryan, chief nurse practitioner for the Walgreens clinics.

But a pile of studies and statistics indicate that not everyone has a regular doctor - by Walgreens' survey of its clients, about 30 percent to 40 percent don't.

"What we see every day is people will come in for an acute illness," Ryan said. "But they'll also have undiagnosed high blood pressure. The question is: What do you do then?"

Until now, the clinic's staff alerted the patient to his or her diagnosis, but all they could do was urge the patient to seek a physician's care. Under Walgreens' new policy, the staff could go further by beginning treatment.

"We can get them care as soon as possible," said Shalan Randolph, who manages 10 clinics Walgreens in Florida.

But even after the patient has begun treatment, Walgreens will continue to refer him to a doctor.

At every turn, Walgreens and CVS say their practitioners refer patients back to their primary care doctors when they have one. If the patient doesn't have one, the pharmacies keep a list of local physicians who will take patients.

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CVS nurse practitioner Lorraine Hendricksen says she's proud of the work she's done, often in coordination with doctors.

This month a woman came in without an appointment for what looked like a dark spot on her leg.

"She came to visit me because she had it for a month. It looked like a scar or a mole. She thought it was something an antibiotic cream might help," Hendricksen recalled.

But Hendricksen, who manages nurse practitioners at multiple CVS clinics in Florida and also sees patients, suspected otherwise and suggested she seek a dermatologist, even made her an appointment with one for the next day.

The patient called later to tell Hendricksen that the doctor had determined it was cancer.